HomeMy WebLinkAboutBuilding Permit #12-1165 y ❑❑�s, c� ❑ o000 � o a y�
4
n �� o 0 0 3��y� z � � mp
b D � � m� m �sZ Z � N ��
z o
� � � � m 0��� O Z O
1�0 , n fA (/1 � Z Z � ��
� � � O � • � �� n
z = m�
� m
� �° �_� � �
� r v ' �
x
'� Z °� � � a000ao
'a m m m m ; � y � ; � �
� N v o m �>m
� c N � "' " � � � x
� m !; � �� b' 3 � � m
b � � z ��g� 8 a . �
o Z q � ��� � v
� A o �
� � �
� y � aa0000 � �
� a c� ����� � � �
�` > m���� � N
� c >mm��
� m a"� � �
~ -�'+ � cZi
oF FR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
�, ,� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT � � � � — � 1 ,
�"
yr�xesa'�r i. �vn"° F'�° PERMIT NO .' 1 r. � �('ys
2. Pink City
3 Yeilow Appiicant !�'
Prease or rint and si at bottom)
ADDRESS ZONING (oFlF�ce use)
�l -�'(o � �mmr`�� �J�^r� �1�L
LEGAL DESCRIPTION (ot1E'ice use oniy)
LOT BLOCK ADDITION PID
� � „ �! y � �"°�� (Phone)
Y'it.t_
(Address) �'l �' 6 �' 1�G�m�?i'n� � i�tr0;� � L
BUII,DER /� �� �� c�s � ��i�t4��.�..
(Company Name) C��,Q.' 1/' (Phone)
(Contact Name) � r � .���5 (Phone) Q�'a`l S
(Address) �.�0/ L� �O� -
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch �e-Roofing ❑Re-Siding ❑Lower I.evei Finish ❑ Fireplace
�Addition �Alterarion ❑Udlity Connection
CODE: ❑I.R.C. ❑I.B.C. O Misc.
Type of Constzuuction: I II III N V A B � a�J�f � O° �
Occupancy Group: A B E F H I M R S U PROJECT COST/VALLTE S i
Division: t 2 3 4 5
(excluding land)
i hereby certify t6at i have fumished inhrrmation on this application which is to the best uf my knowicdge true and correct. t atso cectify that 1 am the owner or authi>rucd agent for the
alwve-menhoned property and that a11 construction will conform to all existing state and local laws and wiil proceed in accordance with submittcd pians. I am aware that the buildmg
uflicial can r voke this permit for just cause. Furthermore, I hereby agree that the city ofFicial or a designee may enrer upon the property to perform needed iacpections.
X �G- (�i `/ �83 3 �lc.�_ 3, ad G�
S' ature Connactor's License No. Date
Permit Valuation Park Support Fee # �
Permit Fee $ ` (/j � s- SAC # $
Plan Check Fee � Water Meter Size 5/8"; 1"; $
5tate Surcharge $ Pressure Reducer $
Penaity $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $
This Application Becomes Your Building Permit When Approved Paid Recei t NO.
'2�"`rL"D. Date - — B
�G�� 1 G-3-��
Buildins Otiicinl Date
Thu �s to certify that the requcst in the above applicahan and accumpanying documenu u in accordance with the Ciry Ziming Ordinance and may proceed u requcsred. This dixvment
when signed by the Ciry Pianner constitutes a temporary Certificate of Zoning compliance and altows construction to cnmmence. Befvre �xcupancy, a Ccrnficate nf Occupancy must be
issucd.
Planning Dimctor Date Special Condidons, if any
24 hour notice for ali inspections (9S2) 447-9850, fax (952) 447-424i
4646 Dakota 5treet Prior Iake, MN 55372